Individuals with alcohol-related diseases, such as alcohol use disorder (AUD), who seek mental health and addiction services are more likely to have better outcomes than those that do not.¹

A team, led by Erik Loewen Friesen, Institute of Health Policy, Management and Evaluation, University of Toronto, used population-based data to evaluate the prevalence of outpatient mental health and addiction service use following alcohol-related hospitalizations and its association with downstream harms.

The Alcohol Problem

Alcohol is currently the leading risk factor for morbidity and premature mortality globally.

“Almost all individuals who are hospitalized for an alcohol-related health condition have a current alcohol use disorder (AUD) or a recent history of AUD and are at a high-risk of recurrent alcohol-related harm following discharge,” the authors wrote.

Alcohol-related hospitalizations are common and often associated with high rates of short-term readmission and mortality. However, rapid access to physician-based mental health and addiction (MHA) services post-discharge could assist in reducing the risk of adverse outcomes in patients with alcohol-related hospitalizations.

The Study

In the population-based historical cohort study, the investigators who experienced an alcohol-related hospitalization between 2016-2018 in Ontario.

The investigators looked at a primary exposure of whether an individual received follow-up outpatient mental health and addiction services from either a psychiatrist or a primary care physician within 30 days of discharge from the index hospitalization.

They sought outcomes of interest of alcohol-related hospital readmission and all-cause mortality in the year following discharge from the index alcohol-related hospitalization.

They also captured data on health service use and mortality using comprehensive health administrative databases. The associations between receiving outpatient mental health and addiction services and the time to each outcome were assessed using multivariable time-to-event regression.

The study included 43,343 individuals, 19.8% (n = 8589) of which received outpatient mental health and addiction services within 30 days of discharge. In addition, 19.1% of patients were readmitted to the hospital and 11.5% of the cohort died in the year following discharge.

Results

Overall, individuals who sought outpatient mental health and addiction services were generally younger (mean age, 45.3 years vs. 53.6 years; SD, 0.50), proportionately more female (37.4% vs. 29.1%; SD, 0.18), more likely to have a psychiatric comorbidity (prior inpatient psychiatric service use, 36.7% vs. 25.2%; SD, 0.25), and more likely to have had their index alcohol-related hospitalization attributed to AUD (57.0% vs. 41.5%; SD, 0.31) than to other diagnoses such as harmful alcohol use (9.8% vs. 16.7%; SD, 0.21) or alcoholic liver disease (2.7% vs. 10.0%, SD: 0.31).

On the other hand, income, medical comorbidity burden, the length of index hospitalization, rural-urban status, and the number of previous alcohol-related hospitalizations were not significantly different between individuals who received mental health and addiction services following index hospitalization and those that did not.

However, mental health and addiction services were linked to a reduced hazard of alcohol-related hospital readmission (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.88-0.99) after adjusting for demographic and clinical covariates. The same was also true for all-cause mortality (aHR, 0.74; 95% CI, 0.66-0.83).

“Short-term outcomes following alcohol-related hospitalizations are poor,” the authors wrote. “Facilitating rapid access to follow-up MHA services may help to reduce the risk of recurrent harm and death in this population.”

References:

1. Friesen, E. L., Yu, W., & Kurdyak, P. (2023). Outpatient Psychiatric Service use is associated with a reduced risk of 1‐year readmission and mortality following alcohol‐related hospitalizations: A historical cohort study. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13560